Utilizes the nursing process to assess, plan, implement, evaluate, and communicate patient care needs for pediatric, adolescent, adult and geriatric patients.
Performs initial nursing assessments and documents findings.
Documents patientsâ™ progress in the medical record on a regular basis including assessment and management plans.
Safely administers medications to patients according to hospital policy and procedures. Conducts second nurse verifications when required.
Reports actual or potential medication variances as well as other patient safety issues utilizing risk master and communication chain of command.
Provides direct patient care, evaluates outcomes and adjusts nursing care processes as indicated to ensure optimal patient care.
Documents patientsâ™ progress in the medical record on a regular.
Collaborates with medical staff and/or multi-disciplinary team to facilitate the recognition, research, isolation and resolution of potential patient care problems for assigned patients.
Provides effective handoff communication utilizing SBAR at change of shift during transfers and to assistive personnel.
Coordinates ongoing patient and family education and discharge planning.
Provides for orientation and training of employees to work routines and environment.
Maintains knowledge of current trends in the field to enhance practice.
Demonstrates knowledge and appropriate use of department equipment and supplies required for the care of patients.
Knowledgeable of emergency resuscitation measures and properly activates code team response.
Complies with department safety policies and procedures. Responsible to help ensure that the safety and well-being of patients, family members, visitors and coworkers are maintained. Follow initiatives for patient safety, including, but not limited to Universal Protocol, Hand Washing and Patient Identification.
Accurately transcribes and carries out physician orders. Completes verbal orders as protocol read back once surgical procedure has started.
Participates in unit specific and multidisciplinary Performance Improvement activities at the Hospital/Unit-based level.
Accurately records, handles and labels specimen; demonstrates care of specimen.
Effectively communicates with the physician in accounting for all sponges, needles, and instruments dur and after the procedure and documents in appropriate area.
